Abstract

Objective: To assess the prevalence of sexually transmitted infections (STI) in a cohort of pregnant urban Indigenous
women and association of STI with preterm birth, low birth weight birth and perinatal mortality.

Design: Prospective intervention program in a cohort of women attending Townsville Aboriginal and Islander Health Services (TAIHS) for shared antenatal care between 1 January 2000 and 31 December 2003 incorporating routine screening for chlamydia, gonorrhoea, trichomoniasis, hepatitis B and syphilis.

Setting: Townsville is a provincial urban centre with a regional Indigenous population of over 16 000.

Participants: Four hundred and fifty-six pregnant women who were screened for bacterial STI and other viral infections.
Main outcome measures: Prevalence of STI, associated risk factors and perinatal outcomes.

Results: Of the 456 women, 403 (88.4%) were screened for chlamydia, gonorrhoea and trichomonas and 432 (94.7%) were screened for syphilis. A total of 92 cases of STI (20.2%, 95% CI 16.5–23.9) were detected, with 21 concurrent infection(s). The overall prevalence of chlamydia was 14.4%, gonorrhoea 6.1%, trichomoniasis 7.2% and infectious syphilis 2.5%. Predictors for STI were young age, harmful/hazardous alcohol use and unwanted pregnancy. Low birth weight and perinatal death were significantly associated with the presence of STI and infectious syphilis during pregnancy.

Conclusion: The prevalence of STI among pregnant women in this urban Indigenous community is high, suggesting that screening for STI should be included in all antenatal care protocols for Indigenous women in Australia. Strategies to reach the whole Indigenous community of child-bearing age, especially those aged less than 25 years, are needed to improve perinatal outcome.